Ellen Hancock, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

BP10057075 Issued in TX

Practice address

209 Ponte Vedra Park Dr.
Ponte Verda Beach, FL 32082

Phone

(904) 273-6200

Fax

(409) 772-1872

NPI assigned

May 2, 2016

Last updated

Sep 7, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ellen Tran Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Plastic and Reconstructive Surgery

Education

University of Texas Medical Branch at Galveston, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ponte Vedra Plastic Surgery, Inc.Group PAC ID 5890786701, 7 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ponte Vedra Plastic Surgery, Inc

  • Specialist
  • Ponte Vedra Beach, FL
  • NPI 1841461100
  Medicare reassignment Care Compare group NPD
• Ponte Vedra Ambulatory Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Ponte Vedra Beach, FL
  • NPI 1760591952
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1316392905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775550724",
            "telephone_number": "409-772-8119",
            "fax_number": "409-772-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 PONTE VEDRA PARK DR.",
            "city": "PONTE VERDA BEACH",
            "state": "FL",
            "postal_code": "32082",
            "telephone_number": "904-273-6200",
            "fax_number": "409-772-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANCOCK",
        "first_name": "ELLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-02",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TX",
            "license": "BP10057075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "TRAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.